Drug Tapering Methods

There are many reasons that people hesitate to undertake drug treatment. One common reason is a fear of the discomfort of withdrawal. People who have previously withdrawn from certain drugs often tell stories of the specific, uncomfortable, and sometimes even painful symptoms they have experienced, and this can make people who hear those stories fearful of going through those symptoms.

However, through professional drug addiction treatment programs, there are methods that can diminish the discomfort of drug detox and withdrawal, helping individuals stay motivated to complete withdrawal and making it more likely that these individuals can complete the treatment process, leading to recovery from addiction or substance abuse. One of these techniques, which is practiced in a variety of ways, is tapering.

What Is Tapering?

When a person is trying to quit an addictive drug, it can be challenging to go cold turkey. Stopping substance use quickly – especially in the case of long-term, heavy drug or alcohol abuse – can lead to uncomfortable symptoms of withdrawal as the body tries to cope with losing the chemical on which it has become dependent. This leads to the following potential types of withdrawal symptoms, as described by WebMD, depending on the substance:

Changes in sleep patterns, including insomnia

Digestive issues, such as nausea, vomiting, and changes in appetite

Sweating, tearing, shakiness, and changes in heart rate or breathing

Emotional instability, including depression, anxiety, irritability, and even violent behavior

Severe cravings to start using the drug again

In the case of alcohol or benzodiazepine abuse, seizures, hallucinations, tremors, and death

Rather than quitting cold turkey, tapering is the process of slowly decreasing the amount of the drug being taken over time. This process can help the body adjust to the loss of the chemical, decreasing the chances for severe withdrawal symptoms. It can also reduce cravings as much as possible, making sure that withdrawal is accomplished without relapsing to use of the substance.

How Tapering Helps

Tapering off a drug gives the body time to adjust to drug cessation. Many drugs of abuse interfere with or substitute for natural body and brain chemistry. Oftentimes, this results in the body or brain losing some ability to manage the natural processes without the help of the drug, as explained by the National Institute on Drug Abuse. Because of this, when the drug is removed suddenly, the body is unable to resume the natural processes, making it unable to function properly. This is the source of the withdrawal symptoms.

However, when a person tapers the drug slowly, the body or brain is able to redevelop its natural processes over time without experiencing the full loss of function that occurs when the drug is suddenly stopped. Depending on the length of the taper and the amount of the decrease at each step, withdrawal symptoms can be minimized.

It is important to note that some drug withdrawal processes can be dangerous. In the case of alcohol or benzodiazepines, stopping suddenly can result in withdrawal symptoms like seizures, hallucinations, and other types of physical fluctuations that can result in death if not treated. Part of the treatment that can help to avoid these problems is professionally monitored tapering that can ease the body off the substance gradually.

Tapering Methods

There are three well-known methods of tapering from drug abuse. These include:

Direct tapering

Substitution tapering

Titration tapering

The process involved in each method and a summary of how it works to manage withdrawal is explained below.

Direct Tapering

Direct tapering is the most straightforward type of taper. This method involves slowly reducing the amount of the drug taken over time. Often, this type of tapering is done on a weekly basis, with the substance reduced by a certain amount each week, until the individual is able to stop use completely.

As described by the Drug Withdrawal Research Foundation, tapering can be supported by providing nutrition that helps to make up for the nutrients lost both as a result of the drug use and as the body responds to the withdrawal process. This nutritional support can contribute greatly to reducing withdrawal symptoms when implemented as part of the direct withdrawal process.

Depending on the length and severity of use and on the substance in question, the degree of taper can be tricky to determine. For this reason, the most reliable method for a direct taper is to work with a drug treatment program professional to determine the best tapering schedule and amounts. This increases the likelihood that the symptoms are minimized properly, helping to avoid cravings and relapse.

Substitution Tapering

Sometimes, short-acting or very low-dose substances can be difficult to taper. Nevertheless, for substances such as benzodiazepines and others, quitting cold turkey can still create a major withdrawal risk. In these cases, it can be better to replace the drug of abuse with a similar but more easily tapered drug to provide the desired withdrawal management, as explained by The Ashton Manual. This is the basis of substitution tapering.

For example, a short-acting or low-dose benzo might be replaced with a longer-acting version of the drug or a similar drug that is easier to step down from. This can make it easier to avoid the severe reactions to withdrawal, such as seizures, that can create a risk for the individual.

Alternatively, a drug like heroin might be replaced with a milder opiate, such as methadone or buprenorphine, which provides less of a high but can still curb the intense cravings that occur with opiate withdrawal. This type of substitution tapering can make it easier for the individual to avoid relapse while tapering down from very strongly addictive drugs.

Titration Tapering

The third common type of tapering is titration tapering. This type of tapering involves dissolving carefully measured amounts of the drug in water to cut the dosage for low-dose drugs. For example, a low-dose benzo can be crushed and dissolved in a specific amount of water, providing measured doses with extremely small, incremental decreases in dose. This can be used to provide daily decreases of tiny amounts, which some feel can result in a very smooth withdrawal process.

There are a number of risks to keep in mind before attempting the titration taper, however. First, as doses can be very difficult to measure in this method, it is important to get medical advice and oversight. Second, some drugs are not water-soluble, meaning that this method would not dilute the amount of drug consumed at all. Similarly, some time-released drugs can be dangerous to crush before consumption, because the entire dose is released at once. For these reasons, water titration may create a higher risk than other forms of titration without the care and oversight of a physician.

Multi-Drug Tapering

Tapering can be very helpful for quitting drug abuse, whether the individual is using a single substance or multiple drugs. However, in the case of polydrug use, additional caution should be used in tapering. The reason for this is that quitting more than one drug at a time can multiply the effects of withdrawal symptoms as the body tries to deal with the loss of more than one chemical it depends on.

As a result, if more than one drug is tapered at the same time, withdrawal can become more severe, erasing the benefit of the taper. For this reason, it is suggested that the individual taper down from one drug at a time. This can be frustrating, as it takes longer to get completely sober. However, it makes it more likely that the individual will avoid severe cravings and other symptoms, and it improves the chances that detox will be completed and the person will avoid relapse.

Children and Tapering

As explained by the Child Mind Institute, tapering down from drug use – whether prescription or illicit – can be extremely important for children. Because smaller doses are often used for children, tapering properly can be a challenge to avoid negative symptoms and develop a stronger desire in the child to keep using the drug.

For children, tapering the drugs properly is just one step. Another important element is to make sure that the other areas of the child’s life are stable before starting a taper. If this is not the case, situations outside the child’s control may lead to increased efforts to keep using the drug, or to a more challenging withdrawal response.

The Necessity of Medical Oversight

Tapering down from drug use or abuse is often the best way to stop use, because it prevents the severe symptoms that can not only create physical discomfort or health risks, but that can also lead to heavy cravings and cause the individual to relapse in an attempt to avoid the worst symptoms. With the guidance of a research-based, experienced treatment program or professional, the process of drug withdrawal can be eased and the individual can complete detox, making it more likely that the individual will also achieve lasting recovery from substance abuse.